OUR LADY OF FATIMA UNIVERSITY

College of Nursing – Valenzuela

PROGRAM Bachelor of Science in Nursing STUDENT NAME

YEAR AND SECTION
COURSE NCMA 113 INSTRUCTOR
DATE

PROCEDURE : PROVIDING GENITAL CARE FOR MALE PATIENT

EXPECTED OUTCOME : The student should be able to provide perineum and genital care for male patient correctly.
ASSESSMENT TASK : Return Demonstration

Exceptional Good Average Poor

Assessment Dimension SCORE
(3) (2) (1) (0)
1. Assess client’s self- Performed the Performed but Performed with Failed to
care abilities. procedure accurately needs minimal slight difficulty, perform the
with evident ease supervision needs supervision procedure
without supervision most of the time
2. Do hand washing. Observed principle of Hand washing was Hand washing was Hand washing
medical hand done with minimal done with maximal was not done
washing error error
3. Prepare materials Gathered the Gathered the Gathered materials Failed to
materials needed materials with little with more time gathered all the
completely time preparation preparation materials
needed
4. Identify client. Explained the Explained the Explained the Failed to explain
Explain procedure. procedure to the procedure but lacks procedure but in an the procedure
Provide privacy. client and significant details unclear manner
others clearly
5. Place water proof Gathered the Gathered the Gathered materials Failed to
pad under the materials needed materials with little with more time gathered all the
client’s buttock. completely time preparation preparation materials
needed
6. Place client in a Demonstrated the Demonstrated the Demonstrated the Failed to
supine position procedures with ease procedure with little procedure with perform the
with legs slightly errors some errors procedure
flexed and hips
slightly externally
rotated.
7. Fold the top bed Performed the Performed but Performed with Failed to
linen to the foot of procedure accurately needs minimal slight difficulty, perform the
the bed. with evident ease supervision needs supervision procedure
without supervision most of the time
8. Cover client’s body Performed the Performed but Performed with Failed to
and leg with the procedure accurately needs minimal slight difficulty, perform the
bath blanket with evident ease supervision needs supervision procedure
without supervision most of the time
9. Drape legs by Performed the Performed but Performed with Failed to
tucking the bottom procedure accurately needs minimal slight difficulty, perform the
corners of the bath with evident ease supervision needs supervision procedure
blanket under the without supervision most of the time
inner side of the
legs.

10. Bring the middle Performed the Performed but Performed with Failed to
portion of the base procedure accurately needs minimal slight difficulty, perform the
of the blanket up with evident ease supervision needs supervision procedure
over the pubic without supervision most of the time
area.
11. Put on clean Performed the Performed but Performed with Failed to
gloves. procedure accurately needs minimal slight difficulty, perform the
with evident ease supervision needs supervision procedure
without supervision most of the time
12. Wash and dry the Performed the Performed but Performed with Failed to
penis using firm procedure accurately needs minimal slight difficulty, perform the
strokes. If client is with evident ease supervision needs supervision procedure
uncircumcised, without supervision most of the time
 retract the prepuce
to expose the glans
penis for cleaning.
Replace the
foreskin after
cleaning the glans
penis.
13. Note any signs of Performed the Performed but Performed with Failed to
inflammation, procedure accurately needs minimal slight difficulty, perform the
excoriation or with evident ease supervision needs supervision procedure
swelling especially without supervision most of the time
in the scrotal folds.
14. Clean and dry Performed the Performed but Performed with Failed to
upper inner thighs. procedure accurately needs minimal slight difficulty, perform the
with evident ease supervision needs supervision procedure
without supervision most of the time
15. Assist client to turn Performed the Performed but Performed with Failed to
onto side facing procedure accurately needs minimal slight difficulty, perform the
away from you. with evident ease supervision needs supervision procedure
without supervision most of the time
16. Clean and dry Performed the Performed but Performed with Failed to
between buttocks procedure accurately needs minimal slight difficulty, perform the
paying particular with evident ease supervision needs supervision procedure
attention to the without supervision most of the time
anal area and
posterior folds of
the scrotum.
17. Dispose linens and Performed the Performed but Performed with Failed to
other soiled procedure accurately needs minimal slight difficulty, perform the
materials properly. with evident ease supervision needs supervision procedure
without supervision most of the time
18. Wash hand. Washed hands and Washed hands and Washed hands but Washed hands
Document documented the some of the details most of the details but
procedure information about of procedure were of the procedure documentation
including unusual the procedure not documented. were not was not done.
findings. properly and documented
completely.

OVERALL SCORE: ________________

Target raw score is 41 out of 54. If raw score is less than 41, repeat the demonstration.

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FACULTY SIGNATURE OVER PRINTED NAME